Hand Carried Ultrasound Utilization in Acute Heart Failure Patients, Does It Correlate with Physical Examination?

Abstract

Purpose Evaluation of intravascular volume is an essential component of clinical management of acute heart failure (HF) patients. Correlation between physical examination and ultrasound measurements has not been well studies and was the focus of this investigation. Methods We prospectively studied patients admitted to the medical floor with acute heart failure exacerbation between January 2017 to October 2018. Assessment of volume status by physical examination (PE) was performed by heart failure team, and classified patient's volume status into (0- euvolemic, 1- Mildly overloaded, 2- Moderately overloaded, 3- Severely overloaded), then central venous pressure (CVP) was measured using hand carried US (assessment of inferior vena cava size and respiratory variation, right and left jugular veins size, respiratory variation and compressibility). Spearman's correlation was used to correlate between PE findings and US-estimated CVP. Finally, the distribution of CVP for each PE category was provided (Figure). Results A total of 186 (Age 64±15,42% females) patients were included during study duration. (34%) patients had HF with preserved ejection fraction (HFpEF), and 104 (66%) patients had HF with reduced ejection fraction (HFrEF). The correlation between PE and US-estimated CVP was moderate at best (rho=0.41, p Conclusion Physical exam is moderately correlated with US-estimated CVP and is unreliable in directing therapy for acute HF exacerbation. Further investigations are needed to integrate hand carried US in the daily management of heart failure patients.